Health Disparities Between Blacks and Whites Widening Instead of Narrowing

Health disparities between blacks and whites in categories including maternal deaths and advanced-stage breast cancer diagnoses are worsening, while only a handful of disparities related to race, ethnicity or income showed significant improvement between 2002 and 2008, a new federal report shows.

Among the few bright spots in the 2011 National Healthcare Disparities Report by the U.S. Agency for Healthcare Research and Quality (AHRQ) is cardiac care, with data showing that blacks received better quality care than whites for more than half of cardiovascular measures. For example, blacks had a lower rate of hospital deaths from heart attacks than whites. And blacks with congestive heart failure were more likely than whites to receive an angiotensin-converting enzyme (ACE) inhibitor, a medication to help heart function, when they left the hospital.

For other conditions, such as cancer and diabetes, blacks typically had worse outcomes than whites. Overall, the report shows that blacks received worse quality care than whites on 41 percent of 182 quality measures, while Hispanics received worse care than whites on 39 percent of 171 quality measures.

Still, small gains are giving federal officials some hope that progress will be made in years ahead with implementation of the Patient Protection and Affordable Care Act.

“For the first time, we are starting to see that — while most disparities are persistent and aren’t going away — we are seeing some improvement in a tiny minority of measures,” said Ernest Moy, medical officer for AHRQ’s Center for Quality Improvement and Patient Safety. “There is a little bit of good news embedded in that.”

Carolyn M. Clancy, director of AHRQ, said she was hopeful that the health care law’s provisions would “reduce health disparities identified in the report and help achieve health equity.”

The congressionally mandated disparities and quality reports, which AHRQ has produced annually since 2003, are based on over 40 different national sources that collect data regularly. The 2011 reports include about 250 health care measures.

Among the findings in the new disparities report:

• Between 2000 and 2007, the overall rate of breast cancer deaths significantly decreased, from 27 to 23 per 100,000 women. Improvements were observed among all racial and ethnic groups except American Indians and Alaska Natives. But in all years, black women had higher breast cancer death rates than white women. Hispanic women had lower rates than non-Hispanic white women.

• Among adults ages 40-64 with diagnosed diabetes, non-Hispanic blacks and Hispanics were less likely than whites to receive the recommended services for diabetes. Blacks and Hispanics also had higher rates of end-stage renal disease due to diabetes than whites.

• Black and Hispanic children had higher rates of emergency department visits for asthma than non-Hispanic whites, an indicator of a lack of preventative care.

• Among nursing home residents, blacks and Hispanics were more likely to suffer from pressure ulcers or bed sores. Nursing homes can help to prevent or heal pressure sores by keeping residents clean and dry and by changing their position frequently or helping them move around.

• In 2008, blacks and Asians were less likely than whites to have a usual primary care provider. The percentage of people with a usual primary care provider also was significantly lower for Hispanics than for non-Hispanic whites. Low-income and middle-income people were significantly less likely than high-income people to have a usual primary care provider.